羥乙基澱粉
Hydroxyethyl Starch (HES)
Hydroxyethyl Starch
別名: Hespan · Hextend · Voluven · Hetastarch · Tetrastarch · Pentastarch · Etherified starches
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Shock bolus (resuscitation) | 10-20 mL/kg | IV | once | — | 🌎 NA |
| Infusion | 1-2 mL/kg/hr; not to exceed 20 mL/kg in a 24 hour period | IV | CRI | 24 hours | 🌎 NA |
| Emergent situations / Colloid oncotic pressure support | 20 mL/kg /day | IV | slow bolus over 15-30 minutes OR 24-hour infusion | — | 🌎 NA |
| Shock resuscitation | 20 mL/kg | IV | bolus | — | 🌎 NA |
- Shock bolus (resuscitation): Rate determined by patient requirements.
- Emergent situations / Colloid oncotic pressure support: For supporting colloid oncotic pressure in hypoalbuminemic patients, give as a 24-hour infusion with low-rate crystalloids.
- Shock resuscitation: Standard dose. Patients may have elevations in PT and aPTT without evidence of bleeding.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Shock bolus (resuscitation) | 5-10 mL/kg | IV | once | — | 🌎 NA |
| Infusion | 1-2 mL/kg/hr; not to exceed 10 mL/kg in a 24 hour period | IV | CRI | 24 hours | 🌎 NA |
| Emergent situations / Colloid oncotic pressure support | 10/mL/kg/day | IV | slow bolus over 15-30 minutes OR 24-hour infusion | — | 🌎 NA |
| Shock resuscitation | 20 mL/kg | IV | bolus | — | 🌎 NA |
- Shock bolus (resuscitation): Administer slower than in dogs to avoid nausea/vomiting.
- Shock resuscitation: Slower in the cat. Rapid administration to cats can cause nausea and vomiting.
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Camelids - Volume expansion | 15 mL/kg | IV | once | — | 🌎 NA |
- Camelids - Volume expansion: Significantly increased COP for up to 96 hours. Transient mild hemodilution and mild increases in PT/PTT noted.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Volume replacement | 10-15 mL/kg over 20-40 minutes, up to four times daily, OR 10-15 mL/kg bolus over 20-40 minutes followed by 1-2 mL/kg/hr continuous rate infusion | IV | up to q6h or CRI | — | 🌎 NA |
| Small volume replacement/CPCR resuscitation | 3-5 mL/kg over 5 min | IV | once | — | 🌎 NA |
| Volume replacement | 3-5 mL/kg IV or IO over 10 minutes, one to two boluses | IV/IO | 1-2 boluses | — | 🌎 NA |
- Volume replacement: Recommended maximum dose is 20 mL/kg/24 hours, though author notes exceeding this without side effects.
- Small volume replacement/CPCR resuscitation: Given after hypertonic saline (3-5 mL/kg). Follow with crystalloids and repeat every 15-20 mins until stable.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Adult horses - volume support | 8-10 mL/kg/day | IV | daily | — | 🌎 NA |
| Foals - rapid volume support | 3-5 mL/kg | IV | once | — | 🌎 NA |
| Hypo-oncotic, well hydrated horses | 0.5-1 mL/kg per hour, up to 10 mL/kg/day | IV | CRI | — | 🌎 NA |
| Volume replacement | 3-10 mL/kg | IV | once | — | 🌎 NA |
| Fluid resuscitation and management of hypoproteinemia | 8-10 mL/kg IV bolus or as a CRI at 0.5-1 mL/kg/hr (max. of 10 mL/kg/day) | IV | bolus or CRI | — | 🌎 NA |
- Foals - rapid volume support: In addition to crystalloids.
- Volume replacement: Total daily doses of 10 mL/kg should not be exceeded due to risk for coagulopathies.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
羥乙基澱粉 (HES) 是一種源自蠟質澱粉（主要由支鏈澱粉組成）的合成膠體體積擴充劑。在獸醫重症監護中，它被用於治療低血容積並提供膠體滲透壓支持。
主要臨床特徵：
- 血管內持久性： 與晶體輸液相比，HES 能提供更好且更持久的血管內體積擴充效果。
- 微血管滲漏症候群： 在全身性發炎的病患中，它有助於降低血管通透性並下調促發炎介質。
- 分子量與取代度： 產品根據其平均分子量 (MW) 和取代度 (DS) 進行分類（例如 HES 450/0.7、HES 130/0.4）。較高的 MW 和 DS 通常會延長血管內半衰期，但會增加凝血異常的風險。
作用機制
HES acts as a synthetic colloid to expand plasma volume through oncotic forces.
- Oncotic Pull: Large HES molecules remain in the intravascular space → increase plasma oncotic pressure → draw fluid from the interstitial space into the blood vessels → expand circulating blood volume.
- Enzymatic Degradation: To prevent rapid breakdown, the glucose units of amylopectin are substituted with hydroxyethyl ether groups.
- Metabolism: Larger molecules are slowly degraded by serum alpha-amylase into smaller fragments → fragments < 50,000 Daltons are rapidly excreted by the kidneys.
安全性與警告
禁忌症
- Severe heart failure
- Severe bleeding disorders
- Oliguric or anuric renal failure
不良反應
- Coagulopathies (prolonged PT/PTT, altered Factor VIII and von Willebrand Factor)
- Nausea and vomiting (especially in cats if administered too rapidly)
- Volume overload leading to pulmonary edema
- Hypersensitivity/anaphylactic reactions (rare)
- Falsely elevated serum amylase levels
- Transient increases in indirect serum bilirubin
- Potential risk for acute kidney injury (extrapolated from human data)
注意事項
Important Warnings & Precautions:
- Coagulation: HES can precipitate Factor VIII and interfere with von Willebrand Factor. Use with extreme caution in patients with pre-existing coagulopathies (e.g., von Willebrand's disease), thrombocytopenia, or those undergoing CNS surgery.
- Renal Risk: Human data suggests a risk of acute kidney injury (AKI), particularly in septic patients. Use cautiously in veterinary patients with pre-existing renal dysfunction or sepsis.
- Volume Overload: Can cause severe circulatory overload. Use with caution in patients with congestive heart failure (CHF), oliguric renal failure, or pulmonary edema.
- Capillary Leak: In severe sepsis, SIRS, or trauma, HES may extravasate into the pulmonary interstitium, potentially causing or worsening pulmonary edema.
- Administration in Cats: Rapid IV boluses in cats frequently cause nausea and vomiting; administer slowly (over 15-30 minutes).
- Not a Blood Substitute: HES has no oxygen-carrying capacity and does not replace the need for RBCs in anemic patients.
藥物相互作用
Do not administer Hextend simultaneously with blood through the same administration set due to a risk of coagulation.
監測
- Fluid status (blood pressure, heart rate, capillary refill time, central venous pressure)
- Coagulation parameters (PT, PTT, platelet count), especially in high-risk patients or with high doses
- Clinical signs of pulmonary edema (respiratory rate/effort, lung auscultation)
- Blood gases
- Renal function (BUN, creatinine, urine output)
藥物動力學
吸收
Immediate volume expansion following intravenous administration. Maximum volume expansion occurs within a few minutes of the completion of infusion.
分佈
Remains primarily within the intravascular space to exert oncotic pressure. In patients with severe capillary leak, it may extravasate into interstitial spaces.
代謝
Larger molecules (>50,000 Daltons) are slowly degraded enzymatically by serum amylase to a size where they can be excreted.
排除
Lower molecular weight molecules (<50,000 Daltons) are rapidly excreted by the kidneys. About 40% of a dose is excreted in the first 24 hours. Practically all the drug is excreted after about 2 weeks.
過量
Overdosage primarily results in intravascular volume overload, which can lead to pulmonary edema and congestive heart failure in susceptible patients. Treatment involves stopping the infusion, carefully monitoring fluid status, and administering diuretics (e.g., furosemide) if pulmonary edema develops.
可用產品
劑型
- 6% HES (450/0.7) in 0.9% sodium chloride (Hespan)
- 6% HES (670/0.75) in lactated electrolyte (Hextend)
- 6% HES (130/0.4) in 0.9% sodium chloride (Voluven)
人用標示
- Hetastarch Injection: 6% (6 g/100 mL) HES (450/0.7) in 0.9% sodium chloride (Hespan)
- Hetastarch Injection: 6% (6 g/100 mL) HES (670/0.75) in lactated electrolyte (Hextend)
- Tetrastarch Injection: 6% (6 g/100 mL) HES (130/0.4) in 0.9% sodium chloride (Voluven)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store at temperatures less than 40°C (104°F); freezing should be avoided. Exposure to temperature extremes may result in the formation of a crystalline precipitate or a color change to a turbid deep brown. Do not use if this occurs.
飼主須知
寵物主人指引：
- 加護病房急救用藥： 羥乙基澱粉 (HES) 是一種僅在醫院環境（通常是加護病房 ICU）中使用的靜脈輸液。
- 使用原因： 它是一種「膠體」輸液，這意味著它含有大分子，能比一般靜脈輸液在血管中停留更長的時間。它被用來快速治療休克、危險的低血壓或嚴重的蛋白質流失。
- 監測： 因為它是一種強效輸液，您的寵物將受到密切監測，以防出現液體超載（可能影響呼吸）和血液凝固功能的變化。
- 費用： 膠體治療及其所需的密集監測可能會顯著增加急診費用。您的獸醫師將與您討論為何您的寵物需要此項治療來穩定病情。
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠方最新藥品說明書。